Volunteer Spotlight: Rosemary Engle

Read a Q& A with DBCC Volunteer and Peer Mentor
Rosemary Engle of Dover


What led you to your involvement with DBCC?

I actually attended the Southern Lights of Life gala before I was involved or knew how to be involved with DBCC. I then called DBCC to inquire about volunteering and was immediately invited to the Peer Mentor Training. I have been involved ever since.

What made you decide to become a peer mentor?
After attending the training, there was no question that this program was a very positive way to be involved with fellow survivors. The training itself gave me a feeling of support that I never experienced since my own diagnosis of breast cancer. We were all able to relate in a special way with each other as we shared a unique common bond. The atmosphere was one that allowed us to comfortably express our feelings and experiences that resulted from our survival journey. I knew that if I could help another survivor to gain that same freedom of expression, then this program was for me.

What have been some of your favorite volunteer opportunities with DBCC?

I have enjoyed every volunteer experience with DBCC, but I must say that being on the Fashion Show Committee for the 2012 Southern Lights of Life Gala has been my favorite opportunity.

What is a memorable moment you have had being a mentor to someone else through their breast cancer journey?
The most memorable moment as a Peer Mentor was when my mentee and I first met for lunch and we really enjoyed sharing so much. We eventually became friends and continue to keep in touch now that she has completed her treatment and can enjoy being cancer-free.

Rosemary (right) with DBCC Program Manager Lois Wilkinson at a Nurture with Nature event

Anything else you would like to add about DBCC or yourself?
I think that all survivors who reach out to DBCC and their various programs are able to continue their involvement and be part of the DBCC family of survivors. There are wonderful programs and events like Nurture With Nature, Southern Lights of Life, volunteer work at various health fairs, educational events, and other community activities that can keep survivors busy and involved year-round. It’s great to be able to help DBCC as a survivor, even in any small way.

Rosemary is the Co-Chair of the Fashion Committee for the 2012 Southern Lights of Life which will be held on Saturday, February 25 from 6 to 10 pm at Dover Downs! Local breast cancer survivors will be models for the evening and wear fashions from local retailers.

If you are a breast cancer survivor and are interested in helping newly diagnosed patients through their journeys, click here to learn more about the Peer Mentor Support Program. To learn more about volunteer opportunities, click here.
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National Breast Cancer Coalition to Host Annual Advocate Summit

Submitted by the National Breast Cancer Coalition (NBCC)
Confused about what’s happening in breast cancer? We’re not. 
The National Breast Cancer Coalition has focused on the goal of ending breast cancer for the past 20 years. Now we have a plan and a deadline on how to get there and when. January 1, 2020!
Join us in Washington, DC May 5-8, for NBCC’s Annual Advocate Summit (formerly the Annual Advocacy Training Conference) to find out how you can be a part of the most important work happening in breast cancer today―Breast Cancer Deadline 2020®. Hear about scientific progress with an uncompromising focus on what really matters… real prevention and a halt to deadly metastasis. Tell your Congressmen all about it on Lobby Day and ask them, along with the President, to make this a priority for the country. Let them know that together we can do this. We’re all about ending breast cancer by the deadline.  
Visit BreastCancerDeadline2020.org/2012Summit to get the most up-to-date information about the NBCC Annual Advocate Summit.
We’re done wasting time. Join us in D.C. May 5-8, 2012. Register Today!

Ask the Doctor: What’s a Breast Ultrasound?

Ask the Doctor with Dr. Jacqueline Napoletano, MD

Breast Ultrasound uses high frequency sound waves. The sound waves travel through tissues (in the breast that is fibroglandular, fat, cysts, and tumors) and bounce off boundaries to produce an image. Ultrasound does not use radiation.

Ultrasound is an adjunctive test, used in addition to mammography, not a replacement for mammography.


Indications for breast ultrasound include: 

  1. Characterization of masses as a cyst or solid mass. 
  2. Characterization of solid masses for low or high probability of malignancy.
  3. Evaluation of a palpable finding (breast lump).
  4. Evaluation of a breast density or mammographic finding. 
  5. Evaluation of nipple discharge.
  6. To guide in breast biopsies.
  7. Potential use in screening in dense breast following a mammogram. 

About Dr. Napoletano

Dr. Napoletano received her Doctor of Medicine in 1989 from the Temple University School of Medicine. She currently serves as a Diagnostic Radiologist and Director of Breast Imaging at the Breast Center at the Helen F. Graham Cancer Center, Christiana Care Health System. She is a Delaware Breast Cancer Coalition (DBCC) Board Member and sits on the advisory committee for the Christiana Care Health System Center of Excellence for Women.

Ask the Doctor: The Truth about Mammograms

Ask the Doctor with Dr. Jacqueline Napoletano, MD

At this time, the cause of breast cancer is unknown, so there is no sure way to prevent breast cancer. Strategies that may help prevent breast cancer include avoiding weight gain and obesity, engaging in regular physical activity, and minimizing alcohol intake. The effect of diet on breast cancer risk remains an active area of research. However, no clear link has been found.

As a result of primarily early breast cancer detection (although some have suggest that it is due to improved treatment), the death rate from breast cancer is 24% lower.

The American Cancer Society recommends women receive an annual mammogram beginning at age 40. Numerous randomized trials have shown that mammography reduces the risk of dying from breast cancer. Early detection also leads to a greater range of treatment options, including less-aggressive surgery (lumpectomy vs. mastectomy) and less-aggressive adjuvant therapy. Breast cancer size at the time of diagnosis is an important factor. Regardless of tumor grade and nodal status, patients with breast cancers less than 1 cm in size have a 20-year survival rate of approximately 87% (Tabar L., Two-County Swedish trial).

If a woman is in a high risk category, screening can be started 10 years earlier. For instance, if your mother’s breast cancer occurred at an age before 40, we start screening 10 years before that age. However, we usually don’t start screening before age 25.

A mammogram is a low dose X-ray of the breast. Every mammogram is unique. No two women have the same appearance on mammography. The breasts are made up of a mixture of fat and glandular elements. The less fat and the more glandular elements create an image of a denser breast. The denser breast tissue decreases the sensitivity of the mammogram for finding the cancer. Mammography has an overall sensitivity for finding cancer of 80%. Digital type mammograms have improved sensitivity in the dense breast. Computer aided detection also gives an “edge” to finding breast cancer and serves as a second set of eyes marking suspicious areas for the Radiologist who reads the mammogram.
 
Mammography does have its limitations. Even with the use of mammography (the best method for detecting early breast cancers), breast cancers will be missed. Not all breast cancer will be detected by a mammogram, and some breast cancers detected by mammography may still have a poor prognosis. Also, a small percentage of breast cancers found by screening, particularly ductal carcinoma in situ, would not have progressed and the treatment may be unnecessary.

Your risk of being called back for additional images after a screening mammogram is overall 10% or less. Only 10% of these returning women will then be recommended for a biopsy. The majority of those women called back will subsequently be given a benign diagnosis or asked to return in 6 months to follow up a finding which is almost certainly benign. In addition, approximately 70-80% of all breast biopsies turn out to be benign.

To be a good screening test, the test must prove that it saves lives, be of low risk and low cost. At the present time mammography is the best screening test we have that meets these criteria and potentially finds a cancer at an earlier stage.

About Dr. Napoletano

Dr. Napoletano received her Doctor of Medicine in 1989 from the Temple University School of Medicine. She currently serves as a Diagnostic Radiologist and Director of Breast Imaging at the Breast Center at the Helen F. Graham Cancer Center, Christiana Care Health System. She is a Delaware Breast Cancer Coalition (DBCC) Board Member and sits on the advisory committee for the Christiana Care Health System Center of Excellence for Women.

Ask the Doctor: What about Breast MRI?

Ask the Doctor with Dr. Jacqueline Napoletano, MD


Magnetic resonance imaging (MRI) uses strong magnetic fields and radio waves to produce a very precise image of the breast. MRI uses no radiation.

MRI is an adjunctive test, performed in addition to mammography and not a replacement for mammography.

In 2007, an expert panel reported new recommendations for the use of MRI screening for women at increased risk for breast cancer. The panel recommended annual screening using MRI in addition to mammography for women at high lifetime risk (20-25% or greater). Women at a moderately increased risk (15%-20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening. MRI screening is not recommended for women whose lifetime risk is less than 15%.

Indications for breast MRI include:

  1. Screening in patients with a high risk of developing breast cancer (20-25% lifetime risk of breast cancer, such as women who carry the BRCA1, BRCA2 genes and women with prior chest wall radiation (such as in treatment for lymphoma).
  2. In some patients with a new diagnosis of breast cancer. This is controversial as MRI in this case has potential benefits (such as finding additional cancer in the same breast or the opposite breast) but also has risks (such as leading to more biopsies that are not cancerous and also increases a woman’s chance of having a mastectomy).
  3. Assess a patient’s response to chemotherapy.
  4. Determine what is scar tissue versus a recurrence of cancer at site of prior surgery.
  5. Evaluation for rupture in silicone breast implants.

Since breast MRI can lead to additional biopsies, the decision to have a breast MRI should be made after discussion of the benefits and the risks with your doctor.

About Dr. Napoletano

Dr. Napoletano received her Doctor of Medicine in 1989 from the Temple University School of Medicine. She currently serves as a Diagnostic Radiologist and Director of Breast Imaging at the Breast Center at the Helen F. Graham Cancer Center, Christiana Care Health System. She is a Delaware Breast Cancer Coalition (DBCC) Board Member and sits on the advisory committee for the Christiana Care Health System Center of Excellence for Women.

Ask the Doctor: Breast Cancer Risk Factors

DBCC talks with Dr. Jacqueline Napoletano, MD. Dr. Napoletano received her Doctor of Medicine in 1989 from the Temple University School of Medicine. She currently serves as a Diagnostic Radiologist and Director of Breast Imaging at the Breast Center at the Helen F. Graham Cancer Center, Christiana Care Health System. She is a Delaware Breast Cancer Coalition (DBCC) Board Member and sits on the advisory committee for the Christiana Care Health System Center of Excellence for Women.

Excluding skin cancer, breast cancer is the most frequently diagnosed malignancy among American women. About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. A man’s lifetime risk of breast cancer is about 1 in 1,000.

Breast cancer is the second leading cause of cancer mortality.

Relevant risk factors:
  1. Being female
  2. Growing older. Incidence increases with age (for women age 50 and older – 375 per 100,000 compared with women under age 50 – 42.5 per 100,000). However, because women under the age of 50 represent about 73% of the female population, 23% of all breast cancers are diagnosed in women under the age of 50. 
  3. Personal history of breast cancer and prior breast biopsies with certain benign diagnoses such at atypia, atypical ductal hyperplasia, lobular neoplasia, and juvenile papillomatosis. 
  4. Family history of breast cancer involving a first degree relative. A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 15% of women who get breast cancer have a family member diagnosed with it. 85% of breast cancers occur in women who have no family history of breast cancer. 
  5. BRCA1 and BRCA2 gene mutations–found in approximately 5-20% of the total percentage of breast and ovarian cancers.
  6. History of chest wall exposure to high dose radiation (such as with prior treatment for lymphoma). 
  7. Other factors implicated with breast cancer risk: early menarche, late menopause, late first-term pregnancy, nulliparity (no full-term pregnancies), postmenopausal obesity, and hormone replacement therapy.
Breast cancer mortality rates (death rates) have declined an average of 2.3% per year between 1990 and 2005. These decreases are thought to be the result of treatment advances, earlier detection through screening and increased awareness.